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The facial nerve (CN VII) mediates facial movements, taste, salivation and lacrimation.

Table: Overview of the Facial Nerve

Cranial Nerve VII: Facial Nerve
Anatomy Cranial Facial Nerve (CN VII)
Nerve
FRCEM Success

Key Exits brainstem in cerebellopontine angle, enters internal auditory meatus and facial canal, exits facial canal and skull via
anatomy stylomastoid foramen

Motor Muscles of facial expression, posterior belly of digastric muscle, stylohyoid muscle, stapedius muscle, parasympathetic
function innervation to lacrimal, salivary, oral, pharyngeal and nasal glands, e erent pathway of corneal blink re ex

Sensory Taste to anterior two-thirds of tongue

function

Assessment Facial movements, corneal blink re ex

Clinical Facial weakness, loss of e erent corneal re ex, impaired lacrimal uid production, hyperacusis, impaired sense of taste to
KEYWORDS e ects of anterior two-thirds of tongue, impaired salivation
Cranial Nerves Facial Nerve
injury

Causes of Bell’s palsy, Ramsay-Hunt syndrome, Guillain-Barre syndrome, mumps, middle ear disease, tumours, trauma
injury
RELATED TOPICS
Anatomy Head and Neck

Cranial Nerve Lesions Face

Function

Something wrong? The facial nerve provides motor innervation to the muscles of facial expression, the posterior belly of the digastric, the stylohyoid and the
stapedius muscles. The chorda tympani branch supplies taste to the anterior two-thirds of the tongue. The facial nerve also carries
parasympathetic innervation to the lacrimal glands, salivary glands, nasal, palatine and pharyngeal mucous glands.

Anatomical Course

The facial nerve arises in the pons, leaves the brainstem in the cerebellopontine angle and exits the posterior cranial fossa through the internal
acoustic meatus in the temporal bone before entering the facial canal still within the temporal bone where it gives rise to three main branches:

The nerve to the stapedius (innervating the stapedius muscle)

The greater petrosal nerve (supplying parasympathetic innervation to the lacrimal gland and the mucous glands of the oral cavity, nose
and pharynx)
The chorda tympani (supplying taste to the anterior two-thirds of the tongue and parasympathetic innervation to all salivary glands below
the level of the oral ssure)

The facial nerve exits the facial canal (and the basal skull) through the stylomastoid foramen between the styloid and mastoid processes of the
temporal bone, at which point it gives o the posterior auricular nerve (innervating the occipital belly of the occipitofrontalis muscle of the scalp
and external ear muscles).

ANATOMICAL COURSE OF THE FACIAL NERVE. (IMAGE MODIFIED BY FRCEM SUCCESS. ORIGINAL BY PATRICK J. LYNCH, ME DICAL IL LUSTRATO R (PATRIC K J.

LYN CH, MEDICAL ILLUSTRATOR) [CC BY 2.5 (HTTP://CRE ATIV ECO MMO NS.O RG/L ICE NSE S/BY/2 .5)] , V IA W IKIMEDIA C OMMON S)

The facial nerve then gives o motor branches (innervating the posterior belly of the digastric muscle and the stylohyoid muscle) before
entering the deep surface of the parotid gland.

Once in the parotid gland, the facial nerve divides into ve terminal branches:

The temporal branch (innervating muscles in the temple, forehead and supraorbital areas)
The zygomatic branch (innervating muscles in the infraorbital area, the lateral nasal area and the upper lip)
The buccal branch (innervating muscles in the cheek, the upper lip and the corner of the mouth)
The marginal mandibular branch (innervating muscles of the lower lip and chin)
The cervical branch (innervating the platysma muscle)

TERMIN AL BRAN CHES OF THE FACIAL NERVE. (IMAGE BY PATRICK J. LYN CH, MEDICAL ILLUSTRATOR (PATRICK J. LYNCH, ME DICAL IL LUSTRATO R) [CC BY 2 . 5

(HTTP://CREATIV ECOMMONS.ORG/LICENSES/BY/2.5)] , V IA W IKIME DIA CO MMO NS)

Assessment

The facial nerve can be assessed by:

Looking for symmetry in the face at rest

Asking the patient to perform the following movements
Raising their eyebrows
Closing their eyes tightly
Blowing out their cheeks
Smiling

Likely Causes of Disease or Injury

Causes of CN VII palsy include:

Bell's palsy (idiopathic)

Ramsay-Hunt syndrome (herpes zoster infection of the CN VII motor ganglion)
Guillain-Barre syndrome
Botulism
Infection e.g. mumps, measles, chickenpox, otitis externa/media, encephalitis, mastoiditis
Tumours e.g. parotid tumours, cerebellopontine angle tumours
Fractures of the petrous temporal bone
Blunt/penetrating trauma to the face or during parotid surgery
Penetrating injury to the middle ear or barotrauma
Brainstem injury

Upper motor neuron (UMN) facial nerve palsy warrants CT head to exclude cerebrovascular events and other intracranial causes such as
tumours, particularly cerebellopontine angle tumours.

Common Clinical E ects

Injury to the facial nerve may result in:

Ipsilateral facial weakness with attening of the nasolabial fold and dropping of the corners of the mouth, drooping of the lower eyelid and
inability to close the eye
Loss of corneal re ex (due to paralysis of the orbicularis oculi muscle)
Impaired lacrimal uid production (due to impaired function of the greater petrosal nerve)
Hyperacusis (hypersensitivity to sound due to impaired function of the nerve to the stapedius)
Impaired sense of taste to anterior two-thirds of tongue and impaired salivation (due to impaired function of the chorda tympani)

If the damage is peripheral (LMN), the forehead will be involved and there will be an inability to close the eyes or raise the eyebrows. If the
damage is central (UMN) there is forehead sparing as the frontalis and orbicularis oculi muscles are innervated bilaterally.